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R E S E A R C H Open Access
Vitamin A decreases pre-receptor amplificationof glucocorticoids in obesity: study on the effectof vitamin A on 11beta-hydroxysteroiddehydrogenase type 1 activity in liver andvisceral fat of WNIN/Ob obese ratsVara Prasad SS Sakamuri1, Prashanth Ananthathmakula1, Giridharan Nappan Veettil2 and
Vajreswari Ayyalasomayajula1*
Abstract
Background: 11b-hydroxysteroid dehydrogenase type 1 (11b-HSD1) catalyzes the conversion of inactive
glucocorticoids to active glucocorticoids and its inhibition ameliorates obesity and metabolic syndrome. So far, no
studies have reported the effect of dietary vitamin A on 11b-HSD1 activity in visceral fat and liver under normal
and obese conditions. Here, we studied the effect of chronic feeding of vitamin A-enriched diet (129 mg/kg diet)
on 11b-HSD1 activity in liver and visceral fat of WNIN/Ob lean and obese rats.
Methods: Male, 5-month-old, lean and obese rats of WNIN/Ob strain (n = 16 for each phenotype) were divided
into two subgroups consisting of 8 rats of each phenotype. Control groups received stock diet containing 2.6 mg
vitamin A/kg diet, where as experimental groups received diet containing 129 mg vitamin A/Kg diet for 20 weeks.
Food and water were provided ad libitum. At the end of the experiment, tissues were collected and 11b-HSD1
activity was assayed in liver and visceral fat.Results: Vitamin A supplementation significantly decreased body weight, visceral fat mass and 11b-HSD1 activity in
visceral fat of WNIN/Ob obese rats. Hepatic 11b-HSD1 activity and gene expression were significantly reduced by
vitamin A supplementation in both the phenotypes. CCAAT/enhancer binding protein a (C/EBPa), the main
transcription factor essential for the expression of 11b-HSD1, decreased in liver of vitamin A fed-obese rats, but not
in lean rats. Liver receptor a (LXRa), a nuclear transcription factor which is known to downregulate 11b-HSD1
gene expression was significantly increased by vitamin A supplementation in both the phenotypes.
Conclusions: This study suggests that chronic consumption of vitamin A-enriched diet decreases 11b-HSD1
activity in liver and visceral fat of WNIN/Ob obese rats. Decreased 11b-HSD1 activity by vitamin A may result in
decreased levels of active glucocorticoids in adipose tissue and possibly contribute to visceral fat loss in these
obese rats. Studying the role of various nutrients on the regulation of 11b-HSD1 activity and expression will help in
the evolving of dietary approaches to treat obesity and insulin resistance.
* Correspondence: [email protected] of Biochemistry, National Institute of Nutrition, Indian Council
of Medical Research, Jamai Osmania PO, Hyderabad-500 604, Andhra
Pradesh, India
Full list of author information is available at the end of the article
Sakamuri et al. Nutrition Journal 2011, 10:70
http://www.nutritionj.com/content/10/1/70
2011 Sakamuri et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.
mailto:[email protected]://creativecommons.org/licenses/by/2.0http://creativecommons.org/licenses/by/2.0mailto:[email protected]7/29/2019 63987911
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Background11b-hydroxysteroid dehydrogenase type 1 (11b-HSD1)
modulates the local glucocorticoid metabolism by cata-
lyzing the conversion of inactive glucocorticoids (corti-
sone in humans and 11-dehydrocorticosterone in
rodents) to active glucocorticoids (cortisol in humans
and corticosterone in rodents). Recent studies have
shown that, 11b-HSD1 plays an important role in the
development of obesity [1,2]. Transgenic mice overex-
pressing 11b-HSD1 in adipose tissue developed visceral
obesity [3], where as 11b-HSD1 knock-out mice dis-
played resistance to diet-induced obesity [4]. Adminis-
tration of carbenoxolone, a non-selective 11b-HSD1
inhibitor, has been shown to decrease obesity in animal
models [5]. 11b-HSD1 gene expression is directly regu-
lated by CCAAT/enhancer-binding protein a (C/EBPa)
[6], where as its expression is down regulated by Liver
receptor a (LXRa) [7].Studies on rodent models of obesity provided valuable
information regarding the molecular mechanisms
involved in the development of obesity and its asso-
ciated complications. WNIN/Ob obese rat colony was
established by selective breeding of spontaneously
mutated obese rat, identified in 80 year-old inbred wis-
tar rat colony at National Institute of Nutrition (NIN,
Hyderabad, India) [8]. The rat colony shows three phe-
notypes (also genotypes), lean (+/+), carrier (+/-) and
obese (-/-). WNIN/Ob lean and carrier rats are fertile,
where as obese rats are sterile. The obese rat colony is
maintained by crossing between carrier rats, whichresults in genotypic ratio (and also phenotypic ratio) of
1:2:1 (lean: carrier: obese) indicating the autosomal co-
dominant nature of the mutation. WNIN/Ob obese rats
develop severe obesity with onset around 35 days of age.
These rats are hyperphagic, hyperinsulinemic, hyperlep-
tinemic and dyslipidemic [8]. Preliminary studies on
WNIN/Ob obese rats have revealed no molecular
defects in leptin and leptin receptor. Recent studies have
located the mutation on 5th chromosome [unpublished
data] and further investigations are underway to identify
the molecular mutation leading to the development of
obesity in these obese rats.
Diet plays an important role in the development, pro-gression and amelioration of chronic diseases like obe-
sity and diabetes. Studies on the effect of nutrients on
11b-HSD1 activity and expression will greatly help in
understanding the mechanisms underlying the develop-
ment of obesity and its associated metabolic disorders.
Vitamin A, an important micronutrient has divergent
biological functions in animal physiology. Vitamin A-
enriched diet has been shown to decrease adiposity and
alter adipose tissue gene expression in rats [9]. Our pre-
vious studies on supplementation of high but non-toxic
dose of vitamin A to obese rats of WNIN/Ob strain
have shown to decrease adiposity [10,11]. So far, no stu-
dies have addressed the role of vitamin A in the regula-
t io n o f 1 1b-HSD1 activity in normal and obese
conditions. As vitamin A is known to alter the expres-
sion of genes regulated by C/EBPa [12], here, we
hypothesize that supra-physiological (high but non-
toxic) dose of vitamin A modulates 11b-HSD1 activity
in adipose tissue under normal and obese conditions.
To test our hypothesis, we studied the activity of 11b-
HSD1 in visceral fat and liver of WNIN/Ob lean and
obese rats, after chronic challenging with vitamin A-
enriched diet (129 mg/Kg diet) for 20 weeks.
MethodsAnimal experiment
Male, 5-month-old WNIN/Ob lean and obese rats (n =
16 for each phenotype) were obtained from the NationalCentre for Laboratory animal sciences, and divided into
two groups A and B based on phenotype. Each group
was further divided into two subgroups (AI, AII & BI,
BII) consisting of 8 rats from each phenotype. The ani-
mals were housed individually in a temperature (22 2
C) and light controlled (12 h cycle) animal facility. Ani-
mals of AI and BI subgroups were fed on stock diet
containing 2.6 mg of vitamin A/Kg diet (Recommended
daily allowance), while those in AII and BII subgroups
were fed on experimental diet containing 129 mg of
vitamin A/Kg diet (as retinyl palmitate- a generous gift
from Nicholas Piramal India Limited). Animals were
maintained on their respective diets for a period of 20
weeks. Food and water were provided ad libitum. Daily
food intake and weekly body weights were recorded.
The study was approved by Institutional Animal Ethical
Committee (IAEC). At the end of the experiment, blood
was collected after overnight fast, between 9.00 AM and
11.00 AM. Animals were sacrificed and tissues were col-
lected and stored at -80C for further analysis.
Plasma and tissue parameters
Plasma corticosterone levels were measured by radioim-
munoassay (RIA) kit method (Siemens, Los Angeles,
USA). Plasma, liver and visceral fat retinol levels weremeasured by methods described previously [10].
Measurement of 11b-HSD1 activity
11b-HSD1 functions as a reductase in vivo, reactivating
corticosterone from inactive 11-dehydrocorticosterone.
However, in tissue homogenates, dehydrogenase activity
predominates, therefore, 11b-HSD1 activity was measured
by the conversion of corticosterone to 11-dehydrocorticos-
terone. We studied 11b-HSD1 activity in visceral fat by
taking omental adipose tissue, as it is known to exhibit
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higher enzyme activity. Post-nuclear fractions from liver
and visceral fat were prepared by centrifuging tissue
homogenate at 1000 g for 20 min. 11b-HSD1 activity was
measured in post nuclear fractions of liver and visceral fat
by incubating in duplicate at 37C in Krebs-Ringer buffer
containing glucose (0.2%), NADP (1 mM) and 1, 2, 6, 7-
[3H4] corticosterone (50 nM). Conditions were optimized
for both tissues to ensure first order kinetics, by adjusting
protein concentrations for liver (40 g/ml) and omental
adipose tissue (1 mg/ml). After incubation (40 min for
liver and 6 h for omental adipose tissue), steroids were
extracted with ethyl acetate, the organic phase was evapo-
rated under nitrogen, and extracts resuspended in mobile
phase (50% water, 30% acetonitrile and 20% methanol).
Steroids were separated by HPLC using reverse phase C18
column and fractions containing corticosterone and 11-
dehydrocorticosterone were collected and radioactivity
was counted in liquid scintillation counter (PerkinElmer,USA).
Measurement of glycerol-3-phosphate dehydrogenase
(GPDH) activity
50 mg of liver tissue was homogenized in 10 mM Tris-
Hcl buffer (pH-7.4) containing 1 mM 2-mercaptoetha-
nol and 5% protease inhibitor cocktail (Sigma, USA).
Homogenate was centrifuged at 10,000 g for 20 minutes
at 4C and the supernatant was used for the estimation
of cytosolic GPDH activity. GPDH activity was mea-
s ured b y the metho d o f White and Kaplan and
expressed as nanomoles of NADH utilized/min/mg of
protein (13).
Measurement of relative gene expression by semi-
quantitative Reverse Transcription PCR
As lean rats have limited omental adipose tissue, which
we utilized for the enzyme assay, we carried out gene
expression work only in liver but not in adipose tissue.
Total cellular RNA from liver was extracted using the
method of Chomczynski and Sacchi [14]. The integrity
of RNA was checked using 1% agarose gels stained with
ethidium bromide. Total RNA was quantified by spec-
trophotometric absorption at 260 nm. 1.0 g of RNA
was used for synthesizing first strand cDNA. Thereverse transcription (RT) reaction was carried out by
incubating RNA with 0.5 g oligo dT primer (Sigma,
USA) and 100 units of Molony murine leukemia virus
reverse transcriptase (Finnzymes, Espoo, Finland) at 37
C for 60 min. Total reaction volume used for RT was
20 L. An aliquot of cDNA was amplified in a 20 L
reaction mixture. PCR conditions are given below: dena-
turation at 94C for 1 minute, annealing at 60-64C for
45 sec and polymerization for 70 C for 1 min with
DyNAzyme II DNA polymerase (Finnzymes, Espoo, Fin-
land). A final extension was carried out at 70 C for 7
min. The amount of RNA and the annealing tempera-
ture for different genes were standardized for linearity.
Sequences of primers used for amplification are 11b-
HSD1: forward primer-5-GAGGAAGGGCTCCAG-3and reverse primer-5-GAGCAAACTTGCTTGCA-
3(NM_017080), LXRa: forward primer-5-GCCCCATG-
GACACCTA-3 and reverse primer-5-TGAGGGTCG
GGTGCAA-3 (NM_031627), C/EBPa: forward primer-
5-GAGCCGAGATAAAGCCAA-3 and reverse primer
5-CTTTCAGGCGACACCA-3 (NM_012524), b-actin:
forward primer-5- ACCAACTGGGACGACATGGA-3and reverse primer-5- TCTCAAACATGATCTGGG
TCA-3 (NM_031144). b-actin mRNA was amplified as
an internal control. Number of amplification cycles for
each gene was standardized so that amplification will be
in the logarithmic phase. After amplification, 8 L of
reaction mixture were electrophoresed on agarose gel
(2%) in Tris-acetate EDTA buffer (pH 8.2). The ethi-dium bromide stained bands were visualized by UV-
transilluminator and analyzed densitometrically using
Quantity One software (Bio-Rad, version 4.4.0).
Immunoblotting
Nuclear protein was extracted from liver as described
previously [15,16]. Protein content was estimated by
Bradford method. Proteins were separated by 10% SDS-
PAGE gel and probed by specific antibodies raised
against C/EBPa and LXRa (Santa Cruz Biotechnology,
Inc., and Santa Cruz, CA). Equal loading of protein and
transfer were ensured by staining membranes with Pon-
seau S. Bands were scanned using GS 710 densitometer
(Biorad, CA, USA) and band densities were analyzed by
Quantity one software (Biorad, version 4.4.0).
Statistics
Data were analyzed by one way ANOVA by using least
significant difference (LSD) post hoc test. Data are pre-
sented as mean S.E. Statistical significance was taken
at P < 0.05 level (two tailed).
ResultsEffect of vitamin A supplementation on physical and
biochemical parametersVitamin A supplementation significantly reduced body
weight, body weight gain and visceral fat mass in obese
rats compared to stock diet-fed obese rats (Table 1).
Vitamin A supplementation did not alter the visceral fat
mass or body weight in lean rats as compared with their
stock-diet fed counterparts (Table 1). Food intake was
not affected by vitamin A supplementation in both the
phenotypes as compared with their respective control
groups (Table 1). Consumption of vitamin A-enriched
diet for 20 weeks significantly increased retinol levels in
liver and visceral fat of lean and obese rats as compared
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with their respective stock-diet fed rats (Table 2).
Plasma corticosterone levels were not altered by vitamin
A supplementation in both the phenotypes (Table 2).
Effect of vitamin A supplementation on 11b-HSD1 activity
in visceral fat
Vitamin A supplementation significantly decreased 11b-
HSD1 activity in visceral fat of obese rats as compared
to stock diet-fed obese rats (Figure 1). In contrast to the
observation in obese rats, vitamin A supplementation
significantly increased 11b-HSD1 activity in visceral fat
of lean rats as compared with their stock diet-fed lean
counterparts (Figure 1).
Effect of vitamin A supplementation on hepatic 11b-HSD1
activity and expression
Vitamin A supplementation significantly decreased 11b-
HSD1 activity in the liver of lean and obese rats as
against their stock diet-fed lean and obese counterparts
(Figure 2). In line with the decreased enzyme activity,
11b-HSD1 mRNA levels were significantly lower in high
vitamin A-fed lean and obese rats as compared with their
stock diet-fed lean and obese counterparts (Figure 2).
Effect of vitamin A supplementation on C/EBPa, LXRa
mRNA and protein levels in liver
To explain the possible mechanism involved in the vita-
min-A mediated downregulation of 11b-HSD1 in liver,
we studied the hepatic expression of C/EBPa and LXRa
both at mRNA and protein levels. Vitamin A supple-
mentation significantly increased the hepatic C/EBPa
gene expression in both the phenotypes (Figure 3) as
compared with their respective control rats. However,
elevated hepatic C/EBPa protein levels were observed
only in vitamin A- supplemented lean rats, where as in
obese rats, hepatic C/EBPa protein levels were signifi-
cantly low (Figure 3). Hepatic LXRa mRNA and protein
levels significantly decreased by feeding of vitamin A
enriched diet to WNIN/Ob lean and obese rats as com-
pared with their respective stock diet fed-lean and obese
counterparts (Figure 4).
Effect of vitamin A supplementation on hepatic glycerol-
3-phospahte dehydrogenase (GPDH) activity
As vitamin A supplementation decreased hepatic 11b-
HSD1 activity in lean and obese rats, we studied the
activity of cytosolic glycerol-3-phosphate dehydrogenase(GPDH), which is induced by glucocorticoids in hepato-
cytes (17). In line with the decreased 11b-HSD1 activity,
GPDH activity was also significantly decreased by vita-
min A supplementation in both the phenotypes as com-
pared with their respective controls (Figure 5).
DiscussionIn this communication, we report the impact of chronic
feeding of vitamin A-enriched diet on 11b-HSD1 activity
in liver and visceral fat of WNIN/Ob obese rats, a new
genetic rat model of obesity. Here, we demonstrate that
Table 1 Effect of vitamin A supplementation on food
intake and physical parameters in WNIN/Ob lean and
obese rats
AI AII BI BII
Pre-treatment body
weight (g)
375 16 362 25 628 38 590 11
Post-treatment bodyweight (g)
406 23 452 15 916 48 778 19*
Body weight (g) 91 20 89 14 285 19 188 14#
Dai ly food intake (g) 18 0.6 18 0.8 26 1.4 26 0.9
Visceral fat (g/100 gbody.wt)
2.3 0.4 2 .5 0.4 10.5 0.7 7 .0 0.5#
Values are mean S.E of 8 rats. Values with # and * mark are significant at P
< 0.01 and < 0.05 level respectively (by one-way ANOVA). Comparisons were
made between normal and high vitamin A-fed groups of each phenotype
(AI-Lean: 2.6 mg vitamin A/Kg diet, AII-Lean: 129 mg vitamin A/Kg diet,
BI-Obese: 2.6 mg vitamin A/kg diet and BII-Obese: 129 mg vitamin A/kg diet)
Table 2 Effect of vitamin A supplementation on
biochemical parameters in WNIN/Ob lean and obese rats
AI AII BI BII
Plasma corticosterone(ng/mL)
227 50 170 15 256 27 287 34
Plasma retinol (g/dL) 28 0.5 28 0.5 40 0.6 43 2.0
Liver total retinol(mg/g tissue)
0.9 0.1 9.8 0.4## 0.4 0.02 8.1 0.3##
Visceral fat retinol(g/g tissue)
4.0 1.2 41 2.7## 2.0 0.1 4.8 2.0##
Values are means S.E of 8 rats. Mean values with## mark are significant at P
< 0.001 level (by one-way ANOVA). Comparisons were made between normal
and high vitamin A-fed groups of each phenotype (AI-Lean: 2.6 mg vitamin
A/kg diet, AII-Lean: 129 mg vitamin A/kg diet, BI-Obese: 2.6 mg vitamin A/kg
diet and BII-Obese: 129 mg vitamin A/kg diet).
Figure 1 Effect of vitamin A supplementation on adipose
tissue 11b-HSD1 activity in WNIN/Ob lean and obese rats .Values are means S.E for 8 rats. Mean values with * mark are
significant at P 0.05 level (by one-way ANOVA). Comparisons were
made between normal and high vitamin A-fed groups of each
phenotype (AI-Lean: 2.6 mg vitamin A/kg diet, AII-Lean: 129 mg
vitamin A/kg diet, BI-Obese: 2.6 mg vitamin A/kg diet and BII-Obese:
129 mg/kg diet).
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feeding of vitamin A-enriched diet to WNIN/Ob obese
rats decreases body weight, fat mass and 11b-HSD1
activity in liver and visceral fat. To our knowledge, this
is the first study to link vitamin A and pre-receptor
metabolism of glucocorticoids in normal and obese
conditions.
Retinoic acid, one of the metabolically-active forms of
vitamin A, regulates cel lular gene express ion through
retinoic acid receptors (RARs) and retinoid receptors
(RXRs). Adipose tissue is a good target organ for vita-
min A action, as it stores significant amount of vitamin
A and expresses RAR and RXR transcription factors.
Retinoic acid is known to inhibit preadipocyte differen-
tiation [18] and remodel white adipose tissue to brown
adipose tissue [19]. Retinaldehyde, another functional
form of vitamin A is reported to decrease adipogenesis
and ameliorate diet-induced obesity in rodent models
[20]. In line with our previous observation, high (but
not toxic) dose of vitamin A decreased visceral fat mass
and bodyweight in obese rats [10]. Previous studies have
reported that cortisol (corticosterone in rodents) is
essential for preadipocyte differentiation [21] and adi-
pose-specific overexpression of 11b-HSD1 in mice,
results in increased preadiocyte differentiation [3]. As
reported previously, WNIN/Ob obese rats have exhib-
ited higher 11b-HSD1 activity in visceral fat than their
lean counter parts [22]. In the present study, vitamin A
significantly decreased 11b-HSD1 activity in visceral fat,
which is associated with significant decrease in visceral
fat mass. Vitamin A mediated visceral fat loss in obese
rats could be due to decreased preadipocyte differentia-
tion, as reduced 11b-HSD1 activity results in decreased
tissue corticosterone levels. In contrast to the observa-
tion in obese rats, vitamin A-challenged lean rats had
increased 11b-HSD1 activity in visceral fat, however,
increased enzyme activity had no impact on visceral fat
mass. The differential effects of vitamin A on 11b-HSD1
activity and visceral fat mass in lean and obese rats
could be due to other physiological factors that are
altered in obese condition.
Figure 2 (A) Effect of vitamin A supplementation on hepatic 11b-HSD1 activity in WNIN/Ob lean and obese rats . Values are means S.Efor 8 rats. Mean values with * mark are significant at P 0.05 level (by one-way ANOVA). (B) Effect of vitamin A supplementation on 11b-HSD1
gene expression in liver of WNIN/Ob lean and obese rats. Quantified densitometric values are expressed relative of 1 for lean control rats (AI). (C)
Representative photo of 11b-HSD1 PCR product, stained by ethidium bromoide. (D) Representative photo of PCR b-Actin product (internal
control), stained by ethidium bromide. Comparisons were made between normal and high vitamin A-fed groups of each phenotype (AI-Lean:
2.6 mg vitamin A/kg diet, AII-Lean: 129 mg vitamin A/kg diet, BI-Obese: 2.6 mg vitamin A/kg diet and BII-Obese: 129 mg/kg diet).
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Vitamin A may regulate the 11b-HSD1 activity, by
altering its gene expression through direct and indirect
mechanisms. Presently, retinoic acid-response elements
are not reported on 11b-HSD1 promoter to support the
direct effect of vitamin A on 11b-HSD1 gene expression.C/EBPa has been shown to be obligatory for the expres-
sion of 11b-HSD1 [4]. Previous studies have reported
that retinoic acid downregulates the expression of genes
like resistin that are regulated by C/EBPa in adipose tis-
sue [13]. Vitamin A-mediated regulation of 11b-HSD1
gene expression in adipose tissue may be mediated by
indirect mechanism through C/EBPa.
11b-HSD1 plays an important role in the regulation of
carbohydrate and lipid metabolism in liver. 11b-HSD1-
KO mice have improved insulin sensitivity [4], where as
transgenic overexpression of 11b-HSD1 in liver results
in the development of impaired glucose tolerance [23].
WNIN/Ob obese rats have lower hepatic 11b-HSD1
expression and activity as observed in other obese
rodent models [22]. In the present study, vitamin A sup-
plementation at high doses decreased hepatic 11b-HSD1activity and expression in both lean and obese pheno-
types. Supporting to our hypothesis, activity of GPDH, a
glucocorticoid inducible enzyme, was also decreased in
vitamin A supplemented lean and obese rats. Based on
these observations, it is possible that vitamin A may reg-
ulate the expression of hepatic glucocorticoid target
genes by regulating the expression of 11b-HSD1.
To understand the possible mechanisms involved in
the downregulation of 11b-HSD1 in liver, we studied
the expression of C/EBPa at mRNA and protein levels.
In our study, vitamin A supplementation increased
Figure 3 (A) Effect of vitamin A supplementation on hepatic C/EBPa mRNA and protein levels in WNIN/Ob lean and obese rats.Quantified densitometric values are expressed relative of 1 for lean control rats (AI). (B) Representative photo of C/EBPa PCR product, stained by
ethidium bromoide. (C) Representative photo ofb-Actin PCR product (internal control), stained by ethidium bromide. (D) Quantified
densitometric values from the western blot are expressed relative of 1 for A-I (lean) as control. (E) Representative Western blot of hepatic C/EBPa
protein. (F) Ponseau stained western blot. Values are means SE for 3-4 rats at P 0.05 level. Comparisons were made between normal and
high vitamin A-fed groups of each phenotype (AI-Lean: 2.6 mg vitamin A/kg diet, AII-Lean: 129 mg vitamin A/kg diet, BI-Obese: 2.6 mg vitamin
A/kg diet and BII-Obese: 129 mg/kg diet).
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hepatic C/EBPa gene expression in vitamin A-treated
lean and obese rats. In contrast to increased mRNA
levels, C/EBPa protein levels decreased in vitamin A-
supplemented obese rats, suggesting the role of post-
transcriptional regulatory mechanisms. Possibly, vitaminA-mediated downregulation of hepatic 11b-HSD1 is
mediated through different mechanisms in lean and
obese rats, in other words, vitamin A-mediated down
regulation of hepatic 11b-HSD1 may be C/EBPa-depen-
dent in obese rats, while it is independent of C/EBPa in
lean rats.
Previous studies have reported that LXRa ligands
down regulate 11b-HSD1 through indirect mechanisms
[7]. In this study, vitamin A supplementation increased
hepatic LXRa mRNA and protein levels in WNIN/Ob
lean and obese rats. In support to the elevated LXRa
Figure 4 (A) Effect of vitamin A supplementation on hepatic LXRa mRNA and protein levels in WNIN/Ob lean and obese rats.Quantified densitometric values are expressed relative of 1 for AI (lean) as control. (B) Representative photo of LXRa PCR product, stained by
ethidium bromoide. (C) Representative photo ofb-Actin PCR product (internal control), stained by ethidium bromide. (D) Quantified
densitometric values from the western blot are expressed relative of 1 for lean control rats (AI). (E) Representative Western blot of hepatic LXR a
protein. (F) Ponseau stained western blot. Values are means SE for 3-4 rats at P 0.05 level. Comparisons were made between normal and
high vitamin A-fed groups of each phenotype (A I-Lean: 2.6 mg vitamin A/kg diet, A II-Lean: 129 mg vitamin A/kg diet, B I-Obese: 2.6 mg
vitamin A/kg diet and B II-Obese: 129 mg/g diet).
Figure 5 Effect of vitamin A supplementation on hepatic GPDH
activity in WNIN/Ob lean and obese rats. Activity was reported as
nmoles of NADH utilized/min/mg protein. Values are means SE
for 8 rats at P 0.05 level. Comparisons were made between normal
and high vitamin A-fed groups of each phenotype (AI-Lean: 2.6 mg
vitamin A/kg diet, AII-Lean: 129 mg vitamin A/kg diet, BI-Obese: 2.6
mg vitamin A/kg diet and BII-Obese: 129 mg/kg diet).
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gene expression, ABCA1 (ATP-binding cassette trans-
porter protein 1), a classical target gene of LXRa is ele-
vated in lean and obese rats (unpublished data). Vitamin
A-mediated downregulation of hepatic 11b-HSD1 gene
expression is may be mediated through LXRa. Another
mechanism, through which dietary vitamin A may down
regulate 11b-HSD1, is by providing high concentration
of RXR ligand, 9-cis-retinoic acid. LXRa forms heterodi-
mer with RXR and this step is essential for LXRa-
mediated gene transcription. Higher concentration of
RXR ligand may result in the increased recruitment of
LXRa:RXR heterodimers to 11b-HSD1 gene promoter
resulting in decreased 11b-HSD1 gene expression.
11b-HSD1 gene expression in liver and adipose tissue
is also regulated by various hormones and cytokines
present in the plasma [24]. It is possible that Vitamin
A-mediated alterations in the levels of these signaling
molecules may also affect the 11b-HSD1 activity in liverand adipose tissue of WNIN/Ob lean and obese rats.
ConclusionsIn summary, we showed for the first time that supra-
physiological dose of vitamin A through diet decreases
11b-HSD1 activity in visceral fat and liver of WNIN/Ob
obese rat. The observed vitamin A-mediated reduction
in 11b-HSD1 activity in the visceral fat of obese rats
may contribute to the decreased visceral fat mass in this
model. Further research is needed to understand the
mechanisms involved in the regulation of 11b-HSD1 by
various nutrients in tissues like liver and visceral fat in
order to develop appropriate dietary interventions to
prevent the development of obesity and insulin
resistance.
List of abbreviations used
11-HSD1: 11-hydroxysteroid dehydrogenase type 1; C/EBP: CCAAT/
Enhancer-binding protein ; LXR: Liver receptor ; RXR: Retinoid
receptor; RAR: Retinoic acid receptor; HPLC: High-performance liquidchromatography; SDS-PAGE: Sodium dodecyl sulphate- polyacrylamide gel
electrophoresis.
Acknowledgements
We are grateful to Dr.B.Sesikeran, Director, of the Institute for constant
encouragement during the conduct of the study. Mr.S.S.S.V.Prasad thanks the
Council for Scientific and Industrial Research (CSIR), India for the award of aresearch fellowship to carryout this work.
Author details1Department of Biochemistry, National Institute of Nutrition, Indian Council
of Medical Research, Jamai Osmania PO, Hyderabad-500 604, Andhra
Pradesh, India. 2National Center for Laboratory Animal Sciences, IndianCouncil of Medical Research, Jamai Osmania PO, Hyderabad-500 604, Andhra
Pradesh, India.
Authors contributionsSSSVP carried out plasma corticosterone and 11-HSD1 assays, gene
expression work, data analysis and prepared the first draft. PA carried out
the animal experiment, immunoblotting work, estimated retinol, GPDH
activity, data analysis and manuscript editing. GNV was responsible for
breeding and supply of animals. VA hypothesized, designed and supervisedthe experiment. VA reviewed, finalized the draft and also gave permission to
submit manuscript. All authors read and approved the content of the
manuscript.
Competing interests
The authors declare that they have no competing interests.
Received: 2 August 2010 Accepted: 23 June 2011
Published: 23 June 2011
References
1. Livingstone DEW, Jones G, Smith K, Jamieson PM, Andrew R Kenyon CJ,
Walker BR: Understanding the role of glucocorticoids in obesity: tissue-
specific alterations of corticosterone metabolism in obese zucker rats.
Endocrinology2000, 141:560-563.
2. Rask E, Olsson T, Soderberg S, Andrew R, Livingstone DE, Johnson O,
Walker BR: Tissue-specific dysregulation of cortisol metabolism in human
obesity. J Clin Endocrinol Metab 2001, 86:1418-1421.
3. Masuzaki H, Paterson J, Shinyama H, Morton NM, Mullins JJ, Seckl JR,Flier JS: A transgenic model of visceral obesity and the metabolic
syndrome. Science 2001, 294:2166-2170.
4. Morton N, Paterson J, Masuzaki H, Holmes MC, staels B, Fieevet C, Walker B,Flier J, Mullins J, Seckl : Reduced 11-Hydroxystweroid dehydrogenase
type 1-mediated intra-adipose glucocorticoid regeneration: a novel
protective adaptation to and treatment for the metabolic syndrome.
Program& Abstracts of the 85th Annual Meeting of the Endocrine Society
2003, 114, June 19-22, abstract OR39-5.
5. Nuotio-Antar Alli M, Hachey David L, Hasty Alyssa H: Carbenoxolone
treatment attenuates symptoms of metabolic syndrome and
atherogenesis in obese, hyperlipidemic mice. Am J Physiol Endocrinol
Metab 2007, 293:E1517-E1528.
6. Williams LJ, Lyons V, MaLeod I, Rajan V, Darlington GJ, Poli V, Seckl JR,
Chapman KE: C/EBP regulates hepatic transcription of 11-
Hydroxystweroid dehydrogenase type 1. A novel mechanism for cross-
talk between the C/EBP and glucocorticoid signaling pathways. J Biol
Chem 2000, 275:30232-30239.7. Stuling TM, Oppermann U, Steffensen KR, Schuster GU, Gustafsson JA: Liver
receptors down regulate 11-Hydroxystweroid dehydrogenase type 1
expression and activity. Diabetes 2002, 51:2426-2433.8. Giridharan NV, Harishankar N, Satyavani M: A new rat model for the study
of obesity. Scand J Lab Anim Sci 1996, 23:131-137.
9. Kumar Monica V, Sunvold Gregory D, Scarpace Philip J: Dietary vitamin A
supplementation in rats: suppression of leptin and induction of UCP1
mRNA. J Lip Res 1999, 40:824-29.
10. Jeyakumar SM, Vajreswari A, Giridharan NV: Chronic dietary vitamin A
supplementation regulates obesity in an obese mutant WNIN/Ob rat
model. Obesity2006, 14:52-59.
11. Jeyakumar SM, Vajreswari A, Giridharan NV: Vitamin A supplementation
induces adipose tissue loss through apoptosis in lean and but not inobese rats of WNIN/Ob strain. J Mol Endocrinol 2005, 35:391-398.
12. Felipie Francisco, Luisa Bonet M, Ribot Joan, Palou Andreu: Modulation of
Resistin Activity by Retinoic Acid and vitamin A status. Diabetes 2004,
53:882-89.
13. White H, Kaplan N: Purification and properties of two types of nucleotide
linked glycerol-3-phosphate dehydrogenase from chicken breast muscle
and chicken liver. J Biol Chem 1969, 244:6031-6039.14. Chomczyski P, Sacchi N: Single step method of RNA isolation by acid
guanidinium thiocyanate phenol chloroform extraction. Anal Biochem
1987, 162:156-9.
15. Qiao L, Maclean PS, Schaack J, Orlicky DJ, Darimont C, Pagliassotti M,
Friedman JE, Shao J: C/EBP regulates human adiponectin gene
transcription through an intronic enhancer. Diabetes 2005,
54:1744-1754.
16. Shao J, Qiao L, Janssen RC, Pagliassotti M, Friedman JE: Chronichyperglycemia enhances PEPCK gene expression and hepatocellular
glucose production via elevated liver activating protein/liver inhibitory
protein ratio. Diabetes 2005, 54:976-984.17. Mayer Robert D, Preston Sheryl L, McMorris F Arthur: Glycerol-3-phosphate
dehydrogenase is induced by glucocorticoids in hepatocytes and
hepatoma cells in vitro. J Cell Physiol 2005, 114(2):203-208.
Sakamuri et al. Nutrition Journal 2011, 10:70
http://www.nutritionj.com/content/10/1/70
Page 8 of 9
http://-/?-http://www.ncbi.nlm.nih.gov/pubmed/10650936?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10650936?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11238541?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11238541?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11739957?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11739957?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15047602?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15047602?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15047602?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/2440339?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/2440339?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15793235?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15919796?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/2440339?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/2440339?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/4310830?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15047602?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/15047602?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16216918?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/16493122?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/12145154?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10906322?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/17878220?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/21698810?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11739957?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11739957?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11238541?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/11238541?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10650936?dopt=Abstracthttp://www.ncbi.nlm.nih.gov/pubmed/10650936?dopt=Abstracthttp://-/?-7/29/2019 63987911
9/10
18. Schwarz EJ, Reginato MJ, Shao D, Krakow SL, Lazar MA: Retinoic acid
blocks adipogenesis by inhibiting C/EBPbeta-mediated transcription. Mol
Cell Biol 1997, 17:1552-61.
19. Mercader Josep, Ribot Joan, Murano Incoronata, Felipe Francisco,Cinti Saverio, Bonet Luisa M, Palou Andreu: Remodeling of White Adipose
Tissue after Retinoic Acid Administration in Mice. Endocrinology2006,
147:5325-32.20. Ziouzenkova Ouliana, Orasanu Gabriela, Sharlach Molly, Akiyama Taro E,
Berger Joel P, Viereck Jason, Hamilton James A, Tang Guangwen,
Dolnikowski Gregory G, Vogel Silke, Duester Gregg, Plutzky Jorge:
Retinaldehyde represses adipogenesis and diet-induced obesity. Nat Med
2007, 13:95-702.
21. Hauner H, Schmid P, Pfeiffer EF: Glucocorticoids and insulin promote the
differentiation of human adipocyte precursor cells in to fat cells. J Clin
Endocrinol Metab 1987, 64:832-835.
22. vara prasad Sakamuri SS, Prashanth Anamthathmakula, Kumar
Pavan Chodavarapu, Reddy Sirisha J, Giridhara Nappan V,
Vajreswari Ayyalasomayajula: A novel-genetically-obese rat model with
elevated 11-hydroxysteroid dehydrogenase type 1 activity in
subcutaneous adipose tissue. Lipids in Health Dis 2010, 9:132.
23. Paterson Janice M, Morton Nicholas M, Fievet Catherine,Kenyon Christopher J, Holmes Megan C, Staels Bart, Seckl Jonathan R,
Mullins John J: Metabolic syndrome without obesity: Hepatic
overexpression of 11-Hydroxystweroid dehydrogenase type 1 intransgenic mice. Proc Natl Acad Sci 2004, 101:7088-7093.
24. Tomlinson Jeremy W, Walker Elizabeth A, Bujalska Iwona J, Draper Nicole,
Lavery Gareth G, Cooper Mark S, Hewison Martin, Stewart Paul M: 11-
Hydroxysteroid Dehydrogenase Type 1: A Tissue-Specific Regulator of
Glucocortcoid Response. Endocrinology2004, 25:831-866.
doi:10.1186/1475-2891-10-70Cite this article as: Sakamuri et al.: Vitamin A decreases pre-receptoramplification of glucocorticoids in obesity: study on the effect ofvitamin A on 11beta-hydroxysteroid dehydrogenase type 1 activity inliver and visceral fat of WNIN/Ob obese rats. Nutrition Journal 2011 10:70.
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